Vaginal and Urinary Microbiome Trial

Inclusion Criteria: * Age 18-years old * Women who qualify for vaginal estrogen * Suitability for follow-up * Hormonally post-menopausal status: Bilateral past ovarian removal, ≥1 year since last menses if uterus in place, OR hysterectomized woman with ≥1 ovary in place AND \>1 year of menopausal symptoms or laboratory confirmation of menopausal hormonal status (such as serum follicle stimulation hormone \>25 IU/mL) * GSM symptoms (including, but not limited to genital symptoms of dryness, burning, itching, and irritation; sexual symptoms of lack of lubrication, discomfort or pain, and impaired sexual function; and urinary symptoms of urgency, frequency, dysuria and recurrent (UTIs) Exclusion Criteria: * Age \< 18-years old * Known allergic reaction or other adverse reactions to Premarin® or any of its components or apricot kernel oil * Nut allergy * Inability to use or place vaginal therapy due to altered mental status or anatomical reasons * Already using vaginal estrogen or apricot kernel oil in the past two weeks * Known active vaginal infection (symptomatic and/or untreated) or completion of treatment for bacterial vaginosis or cervical/vaginal infection within one week of recruitment * History of recurrent or chronic bacterial vaginosis with \> 2 episodes per year or symptoms reported for \> 6 months out of the last year. * History of active vaginal ulcerative disease (active ulcers from atrophy, herpes symptoms at recruitment or herpes with \>2 outbreaks per year or last outbreak \<1month ago, or vaginal laceration. * Chronic antibiotic or probiotic use for indications not listed. * Pelvic organ prolapse beyond the hymenal ring * Using a vaginal pessary or indwelling urinary catheter * Evidence of active urinary tract infection by history and symptoms, urine dipstick, or urine culture on day of presentation or within last 2 weeks (defined as ≥ 100,000 colonies same pathologic bacteria on clean catch or 10,000 colonies on straight catheter specimen) * Recurrent urinary tract infection 3 episodes with the last year or 2 episodes within the last 6 months. * History of venous or arterial thromboembolism or genetic predisposition to thromboembolism. * Ovarian cancer and estrogen responsive cancer including endometrial or breast or breast cancer history of unknown hormonal status * Vaginal mesh erosion, sutures visible in the vagina or granulation tissue * Uncorrected vesicovaginal or rectovaginal fistula * Severe fecal or anal incontinence * Active vulvar dermatoses (lichen sclerosis, Behcet's disease, vulvar eczema) and on chronic topical steroids. * Subjects with absolute contraindications to estrogen, such as diabetes mellitus with end-organ damage and vascular disease, impaired liver function or a hepatic hemangioma, chronic renal disease, migraine with aura, systemic lupus erythematosus with prior thrombosis or vascular damage or other end-organ damage * Patients \< 6 weeks postop * Inability to speak or read English